Techniques of Asian Rhinoplasty
In the realm of nose jobs, there are two types of rhinoplasty – Asian and open, also called Western. The need to differentiate between these two terms stems from the fact that the Caucasian and Asian noses aren’t very similar in appearance. Few people are aware of the distinction. And even fewer understand that the plastic surgeon they go to has to be trained in the particular type of cosmetic procedure they are looking to get. This article will look into several techniques available for Asian rhinoplasty, explaining key things about them.
What is the difference between Western and Asian rhinoplasty?
Since the Caucasian nose is usually bigger, with the bridge positioned high, Western patients normally look for ways to shorten or re-shape their noses. During the operation, the cartilage and the bones in that area are given a different shape for a more elegant appearance. Open rhinoplasty should always be done using a general sedative that will put the patient to sleep. It is the more complicated style of surgery and it lasts 2-3 hours.
The Asian counterpart to a nose job is performed under local anaesthesia and takes about an hour. It is a simple procedure. This means that the downtime is smaller and the risk of complications, although it still exists, minimal.
What is the structure of the oriental nose?
Every nose is different. However, there are certain characteristics which Asians have in common that are absent or different in Caucasian noses. To illustrate this in the best way possible, we will divide the nose into three main parts. The upper one is where the bridge is positioned a little bit lower than what is considered normal in other nations.
More often than not, the dorsum appears to have less projection in the middle part. But that is not all. Some people, the Japanese in particular, also experience a convex dorsum deformity around that area. Now, the lower part of the nose is characterised by a more round tip, absent or poorly defined supra tip break, and less tip projection. When compared to the nasal height, the base appears wider.
Sime Koreans experience alar flaring which is ascribed to hypertrophy of the dilator naris anterior and increased thickness of the skin, among other things.
What are the most commonly requested nasal corrections in Asia?
When it comes to a nose job, the majority of people want to improve their tip projection and augment the dorsum. Another request is to make the infratip lobule full. Along with that, tip reduction and dorsal hump are desired. Those patients who have flat and short noses generally ask for concomitant nasal lengthening, and those presenting with alar flaring require reduction of the ala.
This is pretty much the breakdown of rhinoplasty corrections that the people on the world’s largest continent undergo. Apparently, the standards are different between Western and Oriental countries. To some extent, they are also individual across Asia.
What surgical options are there for Asian rhinoplasty?
Now, let us jump to the types of operations available.
If you are Asian, then silicone implant augmentation is likely to deliver the best results. The nasal implants come in different forms, the two main being L-shaped and I-shaped structures. There are debates about which shape is capable of delivering the most aesthetic results. It really depends on the end goal. The classic option is I-shaped implants, which are mostly focused on increasing the dorsum. They do not help enlarge the tip projection, which means the surgeon will have to do a concomitant tip-plasty to get the job done. Grafting of the cartilage is another option to go by should the patient require tip projection.
However, this means that the implants are not as effective as one would imagine. They are also considered to ensure less support to the tip for being relatively soft.
On the other hand, the L-shaped implants are capable of providing good support and volume at that, wherever necessary. Not to mention, they augment both the tip and the dorsum. This makes them the more popular option. The downside is that the results don’t look natural because the tip projection is more than is necessary.
The good news is that this can be fixed if the columellar part of the item is shortened prior to embedding it into the nose. Another way to go is to add an ear cartilage graft on top of the unit in order to have more control over the fullness and shape.
Now, a small percentage of the patients who have received silicone implants experience complications afterwards, including extrusion, infection, and derivation. In 8% of cases, reoperation is required.
PTFE is a popular technique used in China and Korea. It is often talked of as the Korean-style rhinoplasty and is used to increase the tip and/or dorsum. It represents sheets that have to be moulded into the right shape. They are thinner than silicone implants, which makes them the perfect choice for small nose jobs. If this technique is used for bigger augmentations, then stacking of sheets will be necessary.
When the procedure begins, the surgeon makes two incisions into the sheets, one at the tip and the other at the nasion level. Then they decide the width of the implant, making the necessary corrections. The tip and columella are narrowed down. With that the width of the implant expands, allowing it to reach to the nasion. The doctor carves the implant so that it can fit the dorsum and fixes the thickness by tapering it out at the glabella. That way it can connect with the frontal bone smoothly. At the end, the columella is slimmed down.
Every operation carries risk even if it is performed by a board-certified professional. About 4% of the treated patients experience complications post-surgery, infection being the most reported one. In some cases, these issues might lead to the need to remove the implants.
For this technique, the surgeon collects the cartilaginous pieces of the eight rib. A dorsal onlay graft and columellar strut are then carved. The remaining part of the cartilage is diced into cubes of 1 mm3 and immersed in an antibiotic solution. The liquid is transferred into a syringe with a cut tip (1cc). Then, the Western, or open, kind of rhinoplasty is used to perform the surgery. At the end of the procedure, the specialist places a protective mould onto the nasal dorsum.
Five to seven days afterwards, both the mould and the stitches are removed. The first couple of months patients need to massage their noses ten times a day to reduce swelling. As long as the nose is adequately protected, they can be involved in whatever activities they want to. So, there will be swelling postoperatively; the good news is that it will diminish by one month. You will be able to observe the final shape by the end of the third month or so and full healing will occur after 6-12 months.
The main benefit of using this technique is that one can adjust the nasal shape post-surgery over the course of one to two months. This means that there will be fewer complaints from patients regarding the final shape. And finally, no warping is likely to occur.
This technique is used very rarely because it has been proven to deliver inferior results in Asians. The truth is that autogenous augmentation works best for Caucasians. It can be applied to oriental patients who need a significant tip and dorsal augmentation. The biggest problem that may occur with this technique is the lack of aesthetic results. Large grafts placed on the dorsum can warp with time and bone grafts have the tendency to undergo resorption.
If there are so many techniques, then how does one make the right choice? It’s simple: it is a matter of communication between the patient and the doctor. This is the only way to determine which method will be the most suitable.